title: Transdermal nitroglycerin in patients with severe pre-eclampsia with placental insufficiency: effect on uterine, umbilical and fetal middle cerebral artery resistance indices.
abstract: OBJECTIVE
  To evaluate the effect of transdermal nitroglycerin on Doppler velocity waveforms of the uterine, umbilical and fetal middle cerebral arteries in patients with severe pre-eclampsia.
  
  
  METHODS
  This was a prospective study of 30 singleton pregnancies (gestational age range: 24-31 weeks) with severe pre-eclampsia and abnormal uterine and umbilical artery Doppler waveforms. We compared maternal blood pressure as well as the resistance index (RI) and the pulsatility index (PI) of the uterine, umbilical and fetal middle cerebral arteries before and after application of a transdermal nitroglycerin patch (average dose 0.4 mg/h) for a period of 3 days. Intra-day comparisons before and after administration of nitroglycerin and a comparison between days 0 (no patch) and 3 after administration of the first dose of nitroglycerin were performed using ANOVA for paired samples.
  
  
  RESULTS
  A significant decrease in the PI and RI of the uterine (25.3 ± 4.9% and 21.2 ± 6.2%, respectively, P < 0.001) and umbilical (23.1 ± 6.9% and 19.7 ± 6.1%, respectively, P < 0.001) arteries was noted when comparing the first day without medication against the third day with the patch. No significant change in the PI and RI of the middle cerebral artery was observed. The mean arterial blood pressure decreased from 119.5 ± 4.5 mmHg to 114.8 ± 4.4 mmHg (P < 0.05).
  
  
  CONCLUSIONS
  The use of transdermal nitroglycerin in patients with severe pre-eclampsia is associated with a significant reduction in the RI and PI of the uterine and umbilical arteries, as well as of maternal blood pressure. Transdermal nitroglycerin does not affect the RI and PI of the fetal middle cerebral artery.
authors.affiliation: Hospital of Federal University of Santa Catarina, Florianópolis, SC, Brazil. ginecoalberto@yahoo.com.br
authors.forename: A
authors.initials: A
authors.lastname: Trapani
authors.forename: L F
authors.initials: LF
authors.lastname: Gonçalves
authors.forename: M M de S
authors.initials: MM
authors.lastname: Pires
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity / Q000187:drug effects*; D005260:Female; D005865:Gestational Age; D006801:Humans; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000196:embryology / Q000503:physiopathology; D005996:Nitroglycerin / Q000008:administration & dosage / Q000494:pharmacology*; D010927:Placental Insufficiency / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D011247:Pregnancy; D011446:Prospective Studies; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D014599:Uterus / Q000098:blood supply / Q000000981:diagnostic imaging / Q000187:drug effects; D014655:Vascular Resistance / Q000187:drug effects*
chemical_list: D005996:Nitroglycerin